MEDICARE: DR. BAO KHANH JABBAR D.M.D, M.S., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DDS100057	CA

General Provider Information

NPI Number	:	1831515634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAO KHANH JABBAR D.M.D, M.S., M.P.H.

Provider Business Mailing Address
First Line	:	400 EL CERRO BLVD
Second Line	:	SUITE 106
City	:	DANVILLE
State	:	CA
Zip	:	94526-1731
Country	:	US
Telephone Number	:	925-820-8605
Fax Number	:	925-831-3105

Provider Business Practice Location Address
First Line	:	5700 STONERIDGE MALL RD STE 290
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-2847
Country	:	US
Telephone Number	:	254-631-4509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	04/26/2023

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